P - 84022,_ . RE(�UEST FOR ELECTRICAL INSPECTION -
5 4(� w 0� p Minnesota State Board of Electricity
J � 1821 University Ave., Rm. S-128, St. Paul, MN 55104
Phone(612)642-0800
Home Duplex Apt. Bldg. Other: New Addn
Commercial Indusirial Farm � Remocl Re air
Air Cond. Htg. Equip. Water Htr. Load Mgmt. Other:
Dryer Range Elec. Heat Temp. Service
"X" above the work covered by ihis request. Enter remarks in this space and on ►he back of the white copy only.
Basement finish Combo EJB
Calculate Inspection Fee - This Inspection Request will no► be accepted withoui the correct fee:
Other Fee # Service Entrance Size Fee # Circuits/Feeders
Mobile Home Park Stall 0 to 200 Amps 0 to 100 Amps
Street Ltg./Traffic Sig. Above 200 Amps A�
Fee
Transformer/Generator INSPECTOR'S USE ONLY TOTA
30.50
Sign/Oudine Ltg. Xfmr.
Alarm/Remote Confrol
Swimming Pool
I hereb certi thaf I ins ted fhe elechical installation described herein on the dates stafed
Irrigation Boo Rough-In • ��
Special Inspec �-3
Final �_� � —
Investigative Fee
THIS INSTALLATION MAY BE ORDERED DISCONNECTED IF NOT COMPLETED WITHIN 18 MONTHS.
OFFlCE USE ONLY This request void 18 monfhs from validation dafe printed in this box.
� ���� �� �I� �� l�� I� III �� ��I1� ��� �� �I� �� ��� � ���� �e -� ��� �•�'� _-
* � 5 4 9 � 7 8 4* PLEASE PRINT OR TYPE
Requ�sf�Dpt�,Z / 97 Rougffin inspecfion required? � Yes ❑ No Inspection Other Than RougMn: ❑ Ready Now �Will Call
L��� �You musi call fhe inspecror when ready) Date Ready:
I, � licensed confractor ❑ owner hereby request inspection of the above electrical work �t:
Job Address (Sheet, Box, or Roule No.) City Zip Code
7467 Melody Drive Fridley
Secfion No. Township Name or No. Range No. Fire No. County
Anoka
Occupant
Russ Peterson
Phone No.
784-9085
Power Supplier Atldress
NSP
Elecfrical Conhacfor �Company Name� � Confractor License No.
Joos Electric Co. CA 00961
Mailing Address (Conhacfor or Owner Performing Insfallafion)
3980 Beau D' Rue Drive, Eagan, MN 55122
Avthorized Signature (Conhactor or Owner Performing Ins�lla�qn��;,"� J �—�
BACK OF YELLOW COPY
u�. No.
No.
688-6180